TY - JOUR T1 - Delphi consensus recommendations for a treatment algorithm in pulmonary sarcoidosis JF - European Respiratory Review JO - EUROPEAN RESPIRATORY REVIEW DO - 10.1183/16000617.0146-2019 VL - 29 IS - 155 SP - 190146 AU - Franck F. Rahaghi AU - Robert P. Baughman AU - Lesley Ann Saketkoo AU - Nadera J. Sweiss AU - Joseph B. Barney AU - Surinder S. Birring AU - Ulrich Costabel AU - Elliott D. Crouser AU - Marjolein Drent AU - Alicia K. Gerke AU - Jan C. Grutters AU - Nabeel Y. Hamzeh AU - Isham Huizar AU - W. Ennis James IV AU - Sanjay Kalra AU - Susanna Kullberg AU - Huiping Li AU - Elyse E. Lower AU - Lisa A. Maier AU - Mehdi Mirsaeidi AU - Joachim Müller-Quernheim AU - Eva M. Carmona Porquera AU - Lobelia Samavati AU - Dominique Valeyre AU - Mary Beth Scholand Y1 - 2020/03/31 UR - http://err.ersjournals.com/content/29/155/190146.abstract N2 - Pulmonary sarcoidosis presents substantial management challenges, with limited evidence on effective therapies and phenotypes. In the absence of definitive evidence, expert consensus can supply clinically useful guidance in medicine. An international panel of 26 experts participated in a Delphi process to identify consensus on pharmacological management in sarcoidosis with the development of preliminary recommendations.The modified Delphi process used three rounds. The first round focused on qualitative data collection with open-ended questions to ensure comprehensive inclusion of expert concepts. Rounds 2 and 3 applied quantitative assessments using an 11-point Likert scale to identify consensus.Key consensus points included glucocorticoids as initial therapy for most patients, with non-biologics (immunomodulators), usually methotrexate, considered in severe or extrapulmonary disease requiring prolonged treatment, or as a steroid-sparing intervention in cases with high risk of steroid toxicity. Biologic therapies might be considered as additive therapy if non-biologics are insufficiently effective or are not tolerated with initial biologic therapy, usually with a tumour necrosis factor-α inhibitor, typically infliximab.The Delphi methodology provided a platform to gain potentially valuable insight and interim guidance while awaiting evidenced-based contributions.Expert consensus recommendations for a pulmonary sarcoidosis treatment algorithm from a modified Delphi process include corticosteroids as initial therapy, immunomodulators for steroid-sparing or severe disease, and biologics for very severe disease http://bit.ly/2SmP3uG ER -